A nurse is admitting a client to the birthing unit who started having contractions an hour ago. The nurse determines the client is 80% effaced and 8 cm dilated.
What condition is the client at risk for?

Incompetent cervix

Hyperemesis gravidarum

Postpartum hemorrhage

Ectopic pregnancy

Answer and Explanation

The Correct Answer is C

Choice A rationale
An incompetent cervix is a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. This condition is not directly related to the client’s current state of being 80% effaced and 8 cm dilated.
Choice B rationale
Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest, and antacids.
More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line. This condition is not directly related to the client’s current state of being 80% effaced and 8 cm dilated.
Choice C rationale
Postpartum hemorrhage is a condition that can occur due to a variety of factors, one of which is a rapid or prolonged labor, which can result in uterine atony. Given that the client is 80% effaced and 8 cm dilated, she is in active labor and could potentially be at risk for postpartum hemorrhage.
Choice D rationale

An ectopic pregnancy is a pregnancy in which the fertilized egg implants outside the uterus. The client is already in active labor, which means the pregnancy is not ectopic.

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Correct Answer is C

Explanation

Step 1 is to calculate the number of tablets to administer. The prescription is for 2g of metronidazole and each tablet contains 250mg. To convert grams to milligrams, we multiply by 1000, so 2g is 2000mg. We then divide the total milligrams needed by the milligrams per tablet: (2000mg ÷ 250mg/tablet) = 8 tablets.

A. Press firmly on the client’s suprapubic area. B. Assist the client in pulling their knees toward their abdomen. C. Apply pressure to the client’s fundus. D. Move the client onto their hands and knees.

Correct Answer is B

Explanation

Choice A rationale
Applying firm pressure on the client’s suprapubic area is not part of the McRoberts maneuver. This action is more associated with the suprapubic pressure technique, which is another method used to manage shoulder dystocia.
Choice B rationale
The McRoberts maneuver involves having the client flex her hips against her abdomen. This is achieved by assisting the client in pulling her knees toward her abdomen.
Choice C rationale
Applying pressure to the client’s fundus is not part of the McRoberts maneuver and can be contraindicated as it may cause additional complications.

Choice D rationale
Moving the client onto their hands and knees is not part of the McRoberts maneuver. This position is more associated with the all-fours maneuver, also known as the Gaskin maneuver.

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A nurse is admitting a client to the birthing unit who started having contractions an hour ago. The nurse determines the client is 80% effaced and 8 cm dilated. What condition is the client at risk for?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is caring for a client in the second stage of labor who is experiencing shoulder dystocia. The provider instructs the nurse to perform the McRoberts maneuver. What action should the nurse take?

Correct Answer is B

Explanation

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A nurse is admitting a client to the birthing unit who started having contractions an hour ago. The nurse determines the client is 80% effaced and 8 cm dilated.
What condition is the client at risk for?